Intracoronary stenting: developments since the NICE report

Stenting has become standard treatment for patients undergoing percutaneous coronary intervention. Clinical impressions continue to support this as a user friendly, safe, and efficacious technology The National Institute for Clinical Excellence (NICE) was established in the light of a perceived need for a regulatory body to review the efficacy of existing and new treatments and to appraise technological developments. It was seen as being important for the following reasons: (1) there was and is slow uptake, even of innovations of perceived benefit; (2) judgements on the interpretation or significance of the evidence can be different in different parts of the country, resulting in variations in the access for patients to the new treatments with the widespread perception of inequity; (3) wasteful use of resources can occur when treatments are used outside the range in which they are clinically cost effective, at the expense of alternative uses of those resources which could give greater benefits to patients. The key functions of NICE are technology appraisal of both new and existing interventions, in order to assess clinical benefit and cost effectiveness. Guidelines are issued and information disseminated. It is expected that progress will be audited. Advocates suggest that the good things about NICE include the fact that it was badly needed, and that it is transparent, has authority, and it has been able to rationalise the often difficult debate between clinicians and purchasers. It produces evidence based reports. Its detractors would claim it takes evidence from experts who had “something to sell”, and that it tends to depend too heavily on randomised clinical trials, which select populations, rather than to also use registry data. Recommendations come with no money attached. Overall, however, the establishment and work of NICE has been generally welcomed. For better or worse NICE is seen in Europe as …